Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Abstract

Background: This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) in Thailand. Methods: A retrospective cohort study of patients with HFrEF was conducted. Treatment with a β-blocker and renin-angiotensin system inhibitors (RASIs) with or without mineralocorticoid receptor antagonists (MRAs) at discharge was regarded as guideline-directed medical therapy (GDMT). All others were considered non-GDMT. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects. Results: In total, 653 patients with HFrEF (mean age 64.1 ± 14.3 years; 55.9% male) were included. GDMT with β-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%. During a median of 1-year follow-up, 167 patients (27.5%) had a composite event, 81 patients (13.3%) had all-cause mortality, and 109 patients (18.0%) had HF rehospitalization. Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint (adjusted hazard ratio [HR] 0.63; 95% CI 0.44-0.89; p = 0.009) compared with patients who did not receive GDMT. The use of GDMT was also associated with a significantly lower risk of all-cause mortality (adjusted HR 0.59; 95% CI 0.36-0.98; p = 0.045) and HF rehospitalization (adjusted HR 0.65; 95% CI 0.43-0.96; p = 0.031). Conclusions: For HFrEF treatment, GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization. Nevertheless, prescribing GDMT remains underused, and it could be encouraged to improve HF outcomes in real-world settings.

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

“…In agreement with our results, the ESC Heart Failure Long-Term Registry and the international cohort study by Lam et al also revealed age and blood pressure to be parameters significantly influencing mortality [40,56]. Triple therapy application not only influenced mortality but also independently reduced the risk of all-cause rehospitalisation at 1 year in our study, in accordance with the largest RCTs and international data [57,58].…”

“…A total of 257 patients were involved in our retrospective analysis. A total of 74% of them were male, and the median age was 65 [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] years. A total of 40% of patients required hospitalisation for HF before the index event, 32% were newly diagnosed (de novo) HFrEF patients and 45% had at least partly ischaemic aetiology of HF.…”